Clinical findings

Bouveret syndrome occurs most commonly in elderly women. The presenting clinical situation is
variable and nonspecific but often includes nausea, vomiting, and epigastric
pain.

Radiographic features

Plain film and CT

Rigler's triad (bowel obstruction, pneumobilia, and an
ectopic gallstone) is seen only in a subset of patients. In cases where the offending gallstone is identified, its size (and hence the likelihood of mechanical obstruction) may be underestimated if only the calcified portion of the stone is measured 4.

Ultrasound

Sonography may detect the presence of a cholecystenteric fistula, residual gallstones and gastric outlet obstruction.

Treatment and prognosis

Early diagnosis is important because
mortality is high, with reported figures ranging between 12 - 33%.

Endoscopy is preferred as a therapeutic
option because removal may be performed with mechanical, electrohydraulic, or
laser lithotripsy.

Surgery often is not desirable as the
patients are often poor surgical candidates secondary to concomitant illnesses
and advanced age.